Medicare Drug Coverage Has Bumpy Start

January 4, 2006|By Bob LaMendola Health Writer

Glitches, hitches and switches plagued the first three days of Medicare's new prescription drug coverage, blocking some recipients in South Florida and across the nation from getting their medicine and forcing others to wait.

Although officials on Tuesday said most recipients got their drugs smoothly -- and saved money under the new program -- pharmacies struggled with computer and paperwork problems that clogged the system and thwarted prescriptions.

"As far as they were concerned, I didn't exist," said a Pompano Beach retiree, Nyma Zentner, who went home from the drugstore Tuesday without her blood pressure and osteoporosis pills.

Zentner, like thousands of others, had not yet received a membership card or a welcome letter from the drug plan providing her coverage under Medicare. As a result, the pharmacy could not verify whether she had signed up for coverage.

Officials said many pharmacists tried to check on patients' coverage via a computerized database run by a Medicare contractor, NDCHealth, but the service was responding very slowly during parts of Monday and early Tuesday because of a large volume of requests.

"It's pure madness," said Ira Friedberg, owner of Ira's Discount Pharmacy in Delray Beach. "People don't have their documentation. We can't get through to the plans. They keep you holding for 30 minutes. They really didn't think this through properly."

Medicare officials acknowledged the problems but described them as normal start-up glitches that would be resolved quickly. At least 1 million people got drugs in the first two days, spokesman Peter Ashkenaz said.

"This isn't any different than what would happen to someone who took a new job and got a new health plan, and went to the pharmacy the next day," Ashkenaz said.

Hundreds of thousands enrolled during the final two weeks of 2005, he said, and the government asked the plans to mail confirmations in seven to 10 days.

Among those affected by glitches were some of the sickest recipients: 6.2 million low-income and chronically ill people who used to have drugs covered by state Medicaid. All were automatically enrolled in one of the new drug plans and were supposed to switch to Medicare coverage on Jan. 1.

Andrea Kyle of Deerfield Beach said she tried to refill two of her 15 medications, but the druggist could not find her on the eligibility list and could not dispense the drugs.

Medicare officials said the problem should not exist because all drug plans agreed to give former Medicaid patients at least 30 days of drugs even without full documentation. People should be able to get drugs if they bring their Medicaid and Medicare cards and a picture identification, officials said.

Pharmacists apparently were not aware of the agreements and were refusing to fill some prescriptions, said Valory Greenfield, a staff attorney at Florida Legal Services in Miami. Her brother, Fred, a Medicaid patient, was denied drugs.

As at other stores, pharmacists at Walgreen stores were giving patients a few days of medications to tide them over if glitches blocked their prescriptions, company spokesman Michael Polzin said.

Medicare officials and pharmacy operators predicted that the glitches would ease every day and become only an annoyance before long. "I'm sure it will take weeks before it all gets settled down," Friedberg said.

Bob LaMendola can be reached at blamendola@sun-sentinel.com or 954-356-4526.